On High Risk Pregnancy, Preterm Delivery, VBAC, and the "S Word"

LG was delivered at 38w5d, which was the latest day my OB gave me in a week's window of possible induction dates.  Although neither LG nor I appeared to be in any immediate danger (at least at the time this choice was made...things did indeed get scary when I hit 38 weeks), the logic was (a) I was high risk, (b) I was on heparin, which is more easily managed in induction and (c) due to the aforementioned, there was an increased risk of stillbirth.  While I still resent that OB and the early/failed-induction-c-section that resulted from this proclamation, if I had to do it over I'm not sure I would have chosen differently.  It's really hard to have a doctor start talking about dead babies and not take it seriously, you know?

So, at my last OB visit, we had an eerily similar conversation, the major difference being this time I've got a baby who has the intrauterine equivalent of failure to thrive.  The question thus becomes at what point is he better off outside my body than inside.  And that's what people--and by people I mean friends and acquaintances who ask me about this situation--don't seem to get.  That is, because many people understand the problems caused by prematurity, they assume the closer to full term you get the better off the baby is.  When I say I've had steroids to mature his lungs, they assume it's because I'm at risk of preterm labor, not that my OB will decide to cut him out of my body prematurely because my body is failing him.

I am not, at this point (knock wood and all that hocus pocus), completely freaked out about the possibility of stillbirth; because I'm being monitored twice weekly, chances are really low that my doctor won't catch things going down hill.  But it is a real factor in my/her decision-making process; what I didn't know is that even in normal pregnancies (which I am certainly not having), rates of stillbirth go up once you hit 37 weeks (yes, precisely the time that risks associated with prematurity go down).  That said, I'm completely on board with a mandated c-section at 37ish weeks because I know she would only recommend that if she really believes he's better off in a crib than in my body.  And, honestly, I fully expect that will happen. 

But...if I get to 39 weeks, do I schedule the c-section or hold out for the possibility of VBAC?  Her preference, obviously, is the repeat c-section.  And while mine was VBAC, I'm not sure it makes a lot of sense anymore.  Even though the risks to me go up exponentially with a c-section, I can't see pushing my luck for what amounts to a few more days of intrauterine bonding for the possibility of VBAC and natural delivery.  Even Dr. Gorgeous advised me--before all this stuff went down--not to go much past 39 weeks.  Not worth the risk, she said, to either me or The Boy.  And I'm sure she wasn't really thinking about her DE live birth rate stats when she told me that!

When I asked LG when she thought her brother would be born, she said February 19.  When I said pick a date in November, she said November 10.  Which is, coincidentally, the date of my next growth ultrasound.  Personally, I think 11/11/11 might be a nice consolation prize for the low-risk pregnancy that wasn't.  Stay tuned...